The orthopaedic journals are the most experienced institutions when it comes to high quality information. Most of them have now moved to post a full text version of their "papers" on the Internet but try to support their subscription base by requiring a high price for access to this information. Since the material is posted anyway it would make financial sense to charge a low price and see higher readership. As this changes, the nature of publication is likely to change as Internet-specific features bear fruit. These features include faster turn-around time, integration of feedback into the work and the ease of updating. Those interested in informatics will be trying to hasten and smooth this transition.
Table 1 Comparison of Journal Articles and Internet Pages
Experienced editorial staff
Professional rewards for publishing
Searchable through Medline
Peer Review system
Good & bad
Expensive (barrier to access)
Not fully available
Comprehensive Peer Review (possible)
The peer review system used by the journals is often cited as a key advantage
and by contrast the Internet is condemned because there "is no peer-review"
. This comment ignores the fact that the majority of medical teaching is not peer reviewed. Bedside teaching, operative technique, rounds and teaching seminars are seldom subjected to rigorous review, nor are most presentations at workshops and teaching courses. Yet the majority of orthopaedic CME occurs in this situation. Peer review has its critics. There are relatively few studies on the inter-rater reliability of peer review in orthopaedics.
Further, there is considerable controversy over journal bias
and the fairness and appropriateness of blind peer-review
as currently practiced by the journals
. Fister's summary(2005)
was "We now have plenty of evidence to support the contention that peer review is "expensive, slow, subjective and biased, open to abuse, patchy at detecting important methodological defects, and almost useless at detecting fraud or misconduct."
" Overall the Cochrane Review of the subject
concluded "little empirical evidence is available to support the use of editorial peer review as a mechanism to ensure quality of biomedical research. However, the methodological problems in studying peer review are many and complex. At present, the absence of evidence on efficacy and effectiveness cannot be interpreted as evidence of their absence." Since peer review will be an important part of orthopaedic informatics for the foreseeable future it is important for reviewers to learn how to do it effectively
Peer review on the Internet has the potential for being more immediate, open and productive because alteration and updating of electronic material in response to critique is faster and easier. The "wiki" model
in which the material presented may be amended by multiple users is also very attractive
, provided there is supervision by a competent scientific editor. OrthopaedicsOneis an orthopaedic 'wiki' with participation limited to those with an orthopaedic qualification. The assumption inherent in open authorship is that different points of view will be aired and synthesized with overall improvement in the way in which the material is presented. With all these pressures it is safe to predict that "publication" will not remain unchanged.
There are now many Open Access Journals
in the orthopaedic field. These journals "publish" on the Internet without charging for access to the material
. Authors (or their institutions) are responsible for a fee to cover the costs of the website. By and large these journals offer a traditional approach to peer review and do not take full advantage of the electronic medium and hypertext. These advantages include linkage to other works, illustrations and videos on the Internet and exploiting the full potential of feedback from the readership. Few journals allow links to be incorporated in the text, instead requiring the traditional "endnotes". Works of orthopaedic scholarship rarely provoke responses apart from decorous letters to the editor. This leads to a false sense of completion when a work is published. It would be most stimulating to consider a new work as a challenge for others to take up or round out. This current paper, for example, has made an effort to collect the important examples of published orthopaedic informatics. There are bound to be gaps and deficiencies; it would be more efficient to modify the paper to correct these deficiencies as they come to light than to publish a series of addenda, (conflicting) corrections, or to prepare a whole new paper. This notion of "Collaborative Scholarship" presents, of course, a whole new set of problems - What is authorship? Who decides to accept additions? How are the academic rewards of an on-going scholarly "thread" to be apportioned?